Provider Demographics
NPI:1245779206
Name:PRADA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PRADA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-519-2670
Mailing Address - Street 1:2242 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3804
Mailing Address - Country:US
Mailing Address - Phone:303-718-3435
Mailing Address - Fax:
Practice Address - Street 1:2242 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3804
Practice Address - Country:US
Practice Address - Phone:303-718-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty